Blood pressure changes during labour and whilst ambulating with combined spinal epidural analgesia (original) (raw)
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Bjog an International Journal of Obstetrics Gynaecology, 1997
AbstractObjective To determine the effect of patient-controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour.Design A prospective study.Setting Queen Charlotte's and Chelsea hospital, London.Participants Fifty-five primigravid women in labour at 37 weeks of gestation; 40 women had supervised standing top-ups given by an anaesthetist. A further 15 women had PCEA top-ups given in each of standing, sitting and lying positions.Main outcome measures Maternal pulse rate, blood pressure and fetal heart rate changes following epidural top-ups.Results In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top-ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top-up was given in the lying position. Maternal heart rate increased significantly at 12 min post top-up when the women were in the standing position (P= 0.0018). In the 15 women who had PCEA top-ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position (P < 0.01).Conclusion Patient-controlled epidural analgesia top-ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top-ups in the lying position.
Annals of Anesthesiology and Critical Care, 2019
Background: The pain of vaginal delivery is considered as the worst experience in women life that negatively affects mother and fetus. The most important methods advised by anesthesiologists for pain reduction include epidural and combined spinal-epidural analgesia. The ideal method provides convenient pain relief and guarantees maternal and fetal safety, simultaneously. Fetal heart rate (FHR), fetal movement (FM), and maternal hemodynamics (i.e. blood pressure (BP), heart rate (HR), and SpO2) monitoring are the most available ways for controlling the fetus and mother's conditions during the delivery process. Methods: This randomized-blinded clinical trial was performed on 100 pregnant women (50 cases in each group) during labor under epidural or combined spinal-epidural analgesia using lidocaine, fentanyl, and bupivacaine. FHR, FM, BP, HR, and SpO2 were monitored and recorded by blinded nurses. Data were analyzed by SPSS 22. Results: There were no significant differences in FHR, FM, and Apgar scores between the two groups. No significant difference was found between the two groups in maternal hemodynamics. Generally, FHR, maternal BP, and HR were in the normal ranges. The C/S rate was lower in the epidural group but not statistically significantly. Conclusions: In our survey, epidural and combined spinal-epidural analgesia were comparable in terms of FHR, FM, and maternal hemodynamics. Therefore, there is no priority in using each of the methods. The monitoring of FHR and maternal hemodynamics is essential during analgesia. It is suggested that further surveys evaluate the incidence and causes of C/S after analgesia.
Maternal hemodynamics and computerized cardiotocography during labor with epidural analgesia
Archives of Gynecology and Obstetrics
Purpose To analyze the mechanisms involved in the fetal heart rate (FHR) abnormalities after the epidural analgesia in labor. Methods A prospective unblinded single-center observational study on 55 term singleton pregnant women with spontaneous labor. All women recruited underwent serial bedside measurements of the main hemodynamic parameters using a non-invasive ultrasound system (USCOM-1A). Total vascular resistances (TVR), heart rate (HR), stroke volume (SV), cardiac output (CO) and arterial blood pressure were measured before epidural administration (T0), after 5 min 5 (T1) from epidural bolus and at the end of the first stage of labor (T2). FHR was continuously recorded through computerized cardiotocography before and after the procedure. Results The starting CO was significantly higher in a subgroup of women with low TVR than in women with high-TVR group. After the bolus of epidural analgesia in the low-TVR group there was a significant reduction in CO and then increased again...
Journal of International Medical Research, 2006
The effects of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) were studied in 50 healthy parturients randomly allocated to receive bupivacaine plus fentanyl either epidurally, or intrathecally and epidurally. Significant differences from baseline values were seen in systolic blood pressure at all time-points except for 4 h in the EA group and at 3 and 4 h in the CSEA group. Significant differences from baseline values were seen in diastolic blood pressure at 1, 2, 3 and 4 h in the EA group, whereas no significant differences from baseline were seen in the CSEA group. Pain scores in both groups were significantly decreased compared with baseline and all scores, except at 2h, were significantly lower in the CSEA group compared with the EA group. The duration of labour and total amount of drugs used were significantly decreased and cervical dilatation was faster with CSEA compared with EA. In conclusion, CSEA was associated with more rapid onset of analgesia and faster progress in cervical dilatation compared with EA, and can be used safely for labour analgesia.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Addition of fentanyl to bupivacaine or ropivacaine in epidural space will increase duration and quality of analgesia with similar safety profile. Study aimed to compare epidural Inj. Bupivacaine 0.1% + Inj. Fentanyl and Inj. Ropivacaine 0.1% + Inj. Fentanyl for onset, effectiveness and duration of analgesia, to study motor blockade intensity, to study hemodynamic parameters, to study technical and drug related complications in mother and baby and to study acceptability of technique by patient. Material and methods: A prospective interventional study was conducted on 50 adult females with primigravida / multigravida full term pregnancy for epidural analgesia under ASA 1 & 2. Unpaired Student t test was used to interpret the results. Results: Patients got more pain relief and satisfaction with ropivacaine+fentanyl as compare to bupivacaine+fentanyl. Conclusions: Addition of fentanyl to bupivacaine or ropivacaine in epidural space increase duration and quality of analgesia with similar safety profile and reduce the requirement of local anesthetic drugs during labour. It did not hamper ambulation and bearing down of patient and had similar incidence of maternal and fetal outcome, with good patient satisfaction.
Journal of Prenatal Medicine, 2012
Objective: uteroplacental blood flow is affected by myometrial contractions and hypotension. Epidural analgesia is frequently complicated by hypotension. The aim of the study was to compare the effect of bupivacaine-dexmedetomidine (BD) or bupivacaine -fentanyl (BF) on uterine artery pulsatitly index (UtA-PI) and umbilical artery pulsatitly index (UA-PI) during uterine contractions and relaxations. Methods: this was a prospective controlled observational study performed in 130 healthy full term parturients divided into 3 groups [23 cases as control, 44 cases as (BD) epidural group and 43 cases as (BF) epidural group]. Over the study duration of 120 minutes; UtA-PI and UA-PI were measured at baseline, 30, 60, 120 minutes during uterine contractions and relaxations. Maternal hemodynamic, visual analogue scale (VAS), sedation score, side effects of epidural analgesia including nausea, vomiting, pruritis and respiratory depression were assessed. Results: VAS significantly decreased after epidural compared with control group. BD group showed significant improvement in onset and duration of analgesia and sedation scores with lower incidence of nausea and pruritis compared with BF group. The BF and BD groups were associated with significant maternal hypotension and bradycadia that increase the UtA-PI during uterine contractions and relaxations compared with control group. UA-PI was increased with uterine contractions compared with during uterine relaxations in the three studied groups yet the effect of epidural and uterine contractions does significantly affect newborns apgar scores or umbilical cord pH. Conclusion: bupivacaine-dexmedetomidine epidural analgesia showed better maternal satisfaction for labor pains control compared with bupivacaine -fen-tanyl without deleterious effect on utroplacental circulation and newborns outcome.
Onset of labour epidural analgesia with low-dose bupivacaine and different doses of fentanyl
Anaesthesia, 2017
This study investigated the effects of different doses of epidural fentanyl on the time to onset of epidural analgesia in women in early labour. We hypothesised that onset of epidural labour analgesia (the primary outcome defined as time in minutes from completion of epidural bolus to the first uterine contraction with a numeric pain rating scale [NPRS] score ≤ 3) would be faster with 100 μg of fentanyl epidural bolus compared with 20 μg or 50 μg. Epidural labour analgesia was initiated with 20 μg of fentanyl (F20 group), 50 μg (F50 group) or 100 μg (F100 group) along with 10 ml bupivacaine 0.08% as the loading dose. We randomly allocated 105 patients, with 35 patients in each group. Median (IQR [range]) time to achieve NPRS ≤ 3 was 18 (11-30 [6-20]) min in F20, 10 (8-19 [4-30]) min in F50 and 10 (6-16 [3-30]) min in F100 groups. There was a significant difference in onset times comparing F100 with F20 (p < 0.001) and F50 with F20 (p = 0.007), but not significantly different comp...
Background: Epidural analgesia during labour provides effective pain relief along with better maternal and neonatal outcome. Our aim of the study is to check safety and efficacy of Ropivacaine during labour analgesia. We have also compared cardiotocographic changes in labour with versus without epidural analgesia. Material & Methods: 60 Antenatal cases in between 37-41 weeks of pregnancy in active labour were selected for study. They were randomly divided into 2 groups: Study Group (Group-1): Patients who received epidural ropivacaine for pain relief. Control Group (Group-2): No analgesia was given for pain relief. Epidural catheter was inserted in study group. They were observed for degree of pain relief, requirement of analgesia, intrapartum cardiotocographic changes and maternal tolerability and safety in terms of side effects. They were also asked for their satisfaction towards epidural analgesia.
Background:-Epidural analgesia is the most popular method which can provide excellent pain relief yet, allows the mother to be awake and cooperative during labour. In comparision to bupivacaine, Ropivacaine is less lipid soluble, less cardiotoxic, with less motor block and better haemodynamic stability. Objective:-To study and compare the continuous epidural infusion of Ropivacaine with Fentanyl versus Bupivacaine with Fentanyl for labour analgesia. Methodology:-100 healthy primigravid women, aged 18 to 35 yrs, > than 37 weeks gestation, with spontaneous onset of labour were selected. An epidural catheter was inserted at L2-L3 or L3-L4 level. It was activated after 4cm cervical dilatation with test dose of 3ml 1% lignocaine with 1:200,000 epinepherine. The parturients were randomized into two groups. In Bupivacaine group 8 ml 0.125% Bupivacaine Fentanyl 25 ug followed by continuous infusion of 0.125% Bupivacaine and injection Fentanyl 2 ug /ml at the rate of 6ml/hr was given. In Ropivacaine group 8 ml 0.2% Ropivacaine + Inj Fentanyl 25 ug followed by continuous infusion of 0.2% Ropivacaine with injection Fentanyl 2ug /ml at the rate of 6ml /hr was given. Monitoring was done hrly until they reached 10 cm dilatation and the following data were recorded: maternal blood pressure and heart rate, fetal heart rate, VAS score, motor block , sensory level, mode of delivery, Apgar score, and maternal satisfaction. Results:-In our study, motor block was observed in 13(26%) patients in the Bupivacaine group whereas only five (10%) patients had motor block in Ropivacaine group (P < 0.05) and Eight patients in Bupivacaine group and two patients in Ropivacaine group delivered by assisted vaginal deliveries (P < 0.05). There were no significant differences between the two groups in patient characteristics, maternal haemodynamic variables and patient satisfaction. Conclusion:-Ropivacaine 0.2% combined with fentanyl 2 mcg mL (-1) provided effective analgesia with significantly less motor block and less need.
Acta Anaesthesiologica Scandinavica, 2000
Background: Both paracervical block (PCB) and epidural analgesia are sometimes associated with hemodynamic effects potentially harmful to the well-being of the fetus. Our study was designed to test the hypothesis that PCB would have a more profound effect on maternal and fetal blood flow than epidural analgesia. Methods: Forty-four healthy primiparous parturients were randomized to receive either PCB (nΩ21) or epidural analgesia (nΩ 23) with 25 or 30 mg of bupivacaine, respectively, for labor analgesia. Maternal blood pressure and fetal heart rate were recorded. Blood flow was measured using a color Doppler device. The blood flow measurements consisted of assessment of the pulsatility indices (PI) of the right maternal femoral artery and the main branch of the uterine artery (placental side), the umbilical artery and the fetal middle cerebral artery. The measurements were performed before administration of analgesia and approximately 15-20 min later after the onset of analgesia. Results: Both methods provided in general good analgesia, but rescue medication was required more often after PCB. Epidural analgesia decreased maternal blood pressure more than PCB